The heart is a hollow, muscular organ with four chambers.
- The top two chambers are called the left and right atrium. The right atrium receives blood from the body. The left atrium receives blood from the lungs.
- The bottom two chambers are called ventricles. The right ventricle receives blood from the right atrium and pumps it out to the lungs. The left ventricle receives blood from the left atrium and pumps it out to the rest of the body.
There are four one-way valves in the heart. The valves help direct and regulate blood flow through the heart. These are the tricuspid, aortic, mitral, and pulmonic valves.
- The tricuspid valve controls the blood flow from the right atrium to the right ventricle.
- The pulmonic valve controls the blood flow from the right ventricle to the pulmonary artery. The pulmonary artery carries blood from the right ventricle to the lungs.
- The mitral valve controls blood flow from the left atrium to the left ventricle.
- The aortic valve controls the blood flow from the left ventricle to the aorta. The aorta carries blood out to the body.
Heart valve disorders are usually divided into two types.
- Stenosis occurs when a heart valve can no longer open completely due to thickening, narrowing or stiffness.
- Regurgitation is when blood leaks back through the valve because it does not close completely.
Heart valve replacements or repairs can be completed using standard open-heart surgery, with or without a heart-lung machine, robotic surgery or one of several newer techniques performed through a small incision. When a repair is not possible, a damaged heart valve is replaced with either a biological valve or a mechanical valve. Biological valves, which come from a human cadaver or pig or cow tissue, are durable and people who have them do not usually need to take anticoagulants (blood thinners). New biological valves can last more than 20 years and are often recommended for women who may want to get pregnant and people who:
- Have a history of endocarditis
- Are older than age 50
- Are at high risk for trauma
- Are unlikely to take blood thinners as prescribed
Mechanical valves, which are made from metal and carbon, typically last for the remainder of the recipient's life. They are often recommended for younger people and people who take blood thinners for other reasons.
- Mechanical valves increase the risk of blood clots. Therefore, anti-clotting drugs must be taken indefinitely.
- Regular blood monitoring of some anti-clotting drugs may be needed in order to decrease the risk of bleeding.
- The ticking sound of certain mechanical valves can be bothersome for some people.
At the start of surgery your heart may be stopped.
- If your heart is stopped, a heart-lung machine will be used to put oxygen into your blood and pump it throughout your body.
- The valve replacement will be done while your heart is not moving.
- Your heart will usually start beating on its own after the surgery is done. If it doesn't, it will be restarted with an electrical shock.
Newer, less invasive surgeries may be an option for people who are not good surgical candidates. During this surgery, the valve is replaced through a catheter while the heart is still beating.
- In some cases, a damaged valve may be repaired instead of replaced.
- This is more commonly the case with the mitral and tricuspid valves.
- These surgeries result in a smaller incision, less pain and bleeding, a shorter hospital stay and a faster recovery
If minimally invasive surgery is recommend, ask your surgeon about his experience performing this surgery and what their typical outcomes are?
Discuss the advantages and disadvantages to each type of surgery with your surgeon.
- Based on your circumstances one or more options may not be right for you.
- This care path includes the cost of a heart valve replacement by standard open-heart surgery.
Heart valve disorders may be congenital (present at birth) or develop later in life. Some causes of heart valve disease may include:
- Infection of the heart valve (such as bacterial endocarditis)
- Rheumatic fever
- Inflammation of the inner lining of the heart
- High blood pressure and/or increased blood pressure in the lungs
- Heart disease (such as coronary artery disease and heart failure)
- Inherited connective tissue disorders or autoimmune conditions (such as rheumatoid arthritis)
- Trauma (such as a blunt trauma to the chest or an injury from a cardiac procedure)
- The effect of a rare cancer (carcinoid) that can damage heart valves or a tumor of the heart
- Certain medications
Mild heart valve disorders may not result in any symptoms. A severe heart valve disorder can cause:
- Chest pain or discomfort
- Shortness of breath, especially with exertion
- Palpitations (a feeling of thumping, fluttering, skipping, or racing of the heart)
- Fatigue, dizziness or lightheadedness
- Syncope (sudden brief loss of consciousness)
- Heart failure
- Sudden death
Severe disease affecting the valves on the right side of the heart can also cause:
- Swelling of the arms and legs
- Loss of appetite
- Nausea and vomiting
- Upper right abdominal discomfort
If you develop any of the above symptoms, see your healthcare provider. He or she will check your medical history and give you a physical exam. He or she will use a stethoscope to listen for abnormal heart sounds, including heart murmurs.
- Heart murmurs can occur when blood is forced through a narrow valve or leaks back through a valve.
- Based on the exam, you may be referred to a cardiologist or surgeon for evaluation.
If you do not have symptoms, close monitoring may be sufficient. Based on your specific circumstances, a variety of tests may be ordered to evaluate your heart.
- An electrocardiogram (EKG) to assess the electrical activity of your heart
- Blood and urine tests to provide information about your general health
- A chest x-ray to see if your heart is enlarged
- An echocardiogram, also known as a heart ultrasound done
- A transesophageal echocardiogram, a heart ultrasound done by placing a sensor down your throat into your esophagus
- A heart nuclear scan, a procedure that studies the heart's function and blood flow
- An exercise stress test to help determine how well your heart is working under stress.
- A cardiac catheterization to study your heart and its blood vessels.
Prior to surgery, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before surgery and get clear instructions on what you need to do. These may include:
- Medications you should not take before the surgery, such as blood thinners
- Regular medications you should continue to take on the day of your surgery
- How many hours you should stop eating and drinking before the surgery
If you are a smoker, you should quit smoking. It can interfere with your recovery.
During your surgery, you will receive general anesthesia to keep you comfortable and pain free.
- General anesthesia is when you are put into a deep sleep and are unable to see, hear, or feel anything.
- You will be in the intensive care unit for a period of time after surgery.
- Your nurse will help you get out of bed as soon as possible. This will help decrease the risk of post-operative complications, like blood clots and infection.
- Pain medication and help at home will be needed while you recover.
You may need to take antibiotics before certain procedures if you have a history of:
- An infection of the inner lining of the heart
- A mechanical valve replacement
- A valve repair with mechanical material
- A complex congenital heart defect
If your healthcare provider recommends a valve replacement, ask the following questions.
- What's wrong with my heart valve and which valve is affected? Are there any alternatives to surgery? Why are you recommending one treatment over another?
- Are you recommending a mechanical or biological valve? Why is one type of valve better for me than the other? Will I need to take blood thinners?
- What are the possible complications?
- How will I feel after the surgery? Will I have to modify my activity?
- Do I need any special tests? What are the benefits and risks of having the tests?
- Will the tests change your treatment recommendations? If not, is there a need for them?
- After surgery, what symptoms should I be concerned about? What precautions do I need to take?
- Do I need to take medication before I see a dentist or have other invasive procedures?
- Can my symptoms be controlled with medications? If so, are their Tier 1 or Tier 2 medications on my Prescription Drug List that I should take? How long will I need to take these medications? What are the side effects of my medications?
- How many years have you been doing this type of surgery and what are your typical results 1 year and 5 years after surgery?
- Is your facility designated as a Center of Excellence for cardiac surgery? If so, by whom?
Prior to discharge, make sure you understand all home care instructions. This includes symptoms to report before your next appointment, medications and their side effects, and follow-up plans. Don't forget to arrange for transportation to and from the facility and help at home.